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�- PE� �MIT APPLICATIC"- ) <br /> jCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982Q1 ' <br /> 425-257-8810 -- FAX 425-257-8857 . � " �d7 'Z� � <br /> � <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.# i <br /> �.Z � 0 � (J�ti7- ��lJ -ti 7 S � <br /> LEGA LOTNO. BLOCK TRACT <br /> DES::. <br /> OWNER���yUi 3L-O 1'���-DIlI�(rS A�OFiESS -37Z` ?V���,JAy+ ZIP PHONE <br /> Yt2�� 4L5-111-zLfb <br /> TENANT NAM�E � CONTACT tJAM[ PHONE <br /> ��N�r 36v C1��bl�icrs I 5 N��N 4-�.7 -317'U8 S / � <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N I <br /> � Cr� S Y1F.�TINCr C0 . /n)C_ SCro �195! N�iN S j "7YL7L �' <br /> iPHONE �.{(� r� iZt�L>- W ✓� �iS }���.�I471.�D il <br /> ��� -7�v-73v � <br /> I PROPOSED USE OF BUILDING Building echanical Adaition HEA7 SOURCE � <br /> I ������ �f'r7C...� PERMIT � Combinahon Plumbmg WORK R Aiteratian �Electric � <br /> I — TYPE Demolition Sign TYPE D New Gas I <br /> Sprinkler U fiepair'I:fain;. Oiher � <br /> CONTRACT PRICE OF WORK 7] Ci q 7 O J CITY OF EVERETT LOCAL SALFS TAX CODE IS 3105 'I� <br /> . O � <br /> WORK OESCRIPTION I <br /> , I 1�+ 5 T p-�� I�U ` i W o !Z t� T� ��1 S �/iuC, <br /> j R�c7 � Tc' �' U .tJ � � I <br /> PLUi;�BING MECHnNICAL � <br /> NO. TYPE OF riXTURE OR ITE�d NO. TYPC-OF FIXTURE OR ITEM I <br /> _ WATER CLOSET NC-A/HANDLING U'JITS i <br /> BATHTUu FORCEG AIR SYST�MS <br /> ; _ LAVATOFiY(WASH BASIN) HEAT PUMP I <br /> i = SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 OISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD � <br /> _ LAUNDRY TRAY WATER HEATER � <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URRJAL FIREPLACE INSERT i <br /> � _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> I _ FLUOR DRAIN _ GAS RANGE I <br /> BACKFLOW PREVENTER GAS PIPING <br /> I _ SINK (SERVICE/BAWMOP;ETC.) _L EXHAUST FAN � <br /> _ OTHER OTHER I <br /> — -f Duc.r c..o21L �IJLY I <br /> —� — �i <br /> I NEFEBV CERITIFV 7HAT I HAVE'READ AN�EXAMINED THIS APPIICATION AND KNOW THE SAME TO Bc TRUE AiJD COPRECT. ALL � <br /> PROVISIONS OF LAWS AND ORIDIIJACES GOVERNING THIS TYPE OF WGPK WILI BE COb}pLIEp WI i H V✓HETHER SPECIFIED HEREIN OR , <br /> !JOT. THE GFANTING OF A PERMfi C�1Fc N07 PRESUh1E-0 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIGN OF PNY OTHER �i <br /> STATE OR LOCAI LAW FEGUII+TING CO'�STRUCTION OR l'HE PERFORMANCE CF CONSTRUCTION. THAT I AM PUTHORI:.ED BY iHE � <br /> GWNER OF THIS PROFERN TO PERFORM '�1E WORK FOR WHICH APP�ICATION IS MADE AND I COMPLY WITH THE STATE i <br /> CON?^RACTORS LAW 7927 FCW AND 295.200 b�4C. � <br /> � J�S^'� �� % r �o -D /� 'i <br /> Si�ature oi OwaedContract /Authonzed ent Date � �I <br /> � � <br /> L J <br />